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5-HT2 antagonist (antihistamine)

Pizotifen

Brand names: Sanomigran

Adult dose

Dose: Initial 500 micrograms ON, increase to 1.5mg ON (max 4.5mg/day in divided doses)
Route: PO
Frequency: ON

Clinical pearls

  • Migraine prophylaxis (3rd-line; superseded by topiramate, propranolol, candesartan)
  • Weight gain often limits use

Contraindications

  • Closed-angle glaucoma
  • Urinary retention

Side effects

  • Drowsiness
  • Weight gain
  • Increased appetite
  • Anticholinergic effects

Interactions

  • CNS depressants
  • MAOIs

Monitoring

  • Weight
  • Symptoms

Reference: BNF; NICE CG150; https://bnf.nice.org.uk/drugs/pizotifen/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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